Outcome and Prognostic Factors of Restenosis after Percutaneous Treatment of Native Hemodialysis Fistulas

Clark, Timothy W.I.; Hirsch, David; Jindal, Kailash; Veugelers, Paul J.; LeBlanc, John C.

doi:10.1016/s1051-0443(07)60009-8

Cited by 178 publications

(144 citation statements)

References 22 publications

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“…Although screening for AR can detect stenosis, its performance is inferior to that of Qa in AV fistulae (16). Avoiding the use of any screening strategy and performing angioplasty only for thrombosis or clinically evident stenosis is associated with significantly lower patency rates (50 to 70% at 12 mo) (17,18). In addition, angioplasty of subclinical stenosis is associated with improved dialysis delivery (1); therefore, this expectant strategy might result in morbidity due to under-dialysis.…”

Section: Discussionmentioning

confidence: 99%

Access Flow Monitoring of Patients with Native Vessel Arteriovenous Fistulae and Previous Angioplasty

Tonelli¹,

Hirsch²,

Clark

et al. 2002

Journal of the American Society of Nephrology

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Abstract. Screening strategies based on measurement of access blood flow (Qa) allow detection and angioplasty of subclinical stenosis in native vessel arteriovenous (AV) fistulae. However, little is known about the efficacy of Qa measurements for detecting recurrent stenoses in fistulae and that of angioplasty for correcting them. A total of 303 patients were studied over 30 mo; 69 (23%) of these had stenoses, of whom 53 underwent angioplasty. Of those undergoing angioplasty, 30 patients had 46 episodes of recurrent positive studies and underwent repeat fistulography. In 31 of these episodes (19 patients), stenosis was again identified and treated successfully with angioplasty. Overall positive predictive values for stenosis were similar in first and subsequent episodes of stenosis (71% versus 67%), and angioplasty was associated with sustained increases in Qa for both first and subsequent episodes. Assisted patency in fistulae that required repeat angioplasty was 87% (median follow-up 10 mo after the second angioplasty). In conclusion, Qa is effective for detecting first and subsequent lesions in patients with AV fistulae, and angioplasty of first or subsequent lesions is associated with sustained increments in Qa. Continued screening after correction of first stenoses appears reasonable, because of both the frequency of recurrent stenosis and the success of repeat intervention.Ultrasound dilution measurement of access blood flow (Qa) has been shown to accurately identify first episodes of subclinical stenosis in native vessel fistulae (1). Most such stenoses, once identified, are amenable to percutaneous angioplasty, which is associated with short-term improvements in Qa and dialysis delivery. Although access screening programs have been shown to prolong the use-life of polytetrafluoroethylene (PTFE) grafts (2) and cohorts of mixed access type (3), little data exists on the effect of such programs on native arteriovenous dialysis fistulae (4 -6).The diagnostic performance of Qa in native vessel fistulae that have previously undergone angioplasty for stenosis is unknown. The positive predictive value of screening might differ substantially in this population compared with unselected fistulae, both because of the prevalence of stenosis and because of mechanical effects of angioplasty on the native vessel conduit. Finally, the effectiveness of angioplasty for correcting recurrent stenoses in fistulae is unclear. These data will become increasingly relevant as access screening programs are implemented in more dialysis centers and the prevalence of fistulae with previously angioplastied stenosis increases.There were two objectives for the current study. The first was to determine the positive predictive value of ultrasound dilution techniques (UDT) for the detection of subclinical stenoses in fistulae that have previously undergone angioplasty. The second was to document the efficacy of angioplasty at correcting stenoses in fistulae that have previously undergone angioplasty. In both cases, results from those with ...

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Section: Discussionmentioning

confidence: 99%

Access Flow Monitoring of Patients with Native Vessel Arteriovenous Fistulae and Previous Angioplasty

Tonelli¹,

Hirsch²,

Clark

et al. 2002

Journal of the American Society of Nephrology

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“…The patency of PTA is limited, however, with first year primary patency rates ranging between 26% and 62% (6-8). Many factors influencing the patency rate have been studied in previously reported series (7,8). Our study is the first to investigate the effect of early recurrence on secondary patency.…”

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confidence: 86%

“…Despite proven advantages of AVF over PTFE, both types of access eventually fail and contribute to multiple hospital admissions, radiological and surgical interventions, and overall morbidity associated with chronic hemodialysis. Significant stenosis causing access dysfunction is a frequent complication in hemodialysis and requires repeated percutaneous transluminal balloon angioplasty (PTA) to maintain patency (6)(7)(8)(9). The patency of PTA is limited, however, with first year primary patency rates ranging between 26% and 62% (6)(7)(8).…”

mentioning

confidence: 99%

“…Significant stenosis causing access dysfunction is a frequent complication in hemodialysis and requires repeated percutaneous transluminal balloon angioplasty (PTA) to maintain patency (6)(7)(8)(9). The patency of PTA is limited, however, with first year primary patency rates ranging between 26% and 62% (6)(7)(8). Many factors influencing the patency rate have been studied in previously reported series (7,8).…”

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confidence: 99%

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Percutaneous transluminal balloon angioplasty in stenosis of native hemodialysis arteriovenous fistulas: technical success and analysis of factors affecting postprocedural fistula patency

Aktaş

Bozkurt²,

Aktaş³

et al. 2015

Diagn Interv Radiol

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RESULTSA total of 330 stenoses were found in 228 patients. PTA was technically successful in 96.3% of the stenoses (n=319). Clinical success was achieved in 97.2% (n=321). Early dysfunction (within six months) was positively correlated with patient age (P < 0.001) and diabetes (P < 0.005). Older age (P < 0.001) and diabetes (P = 0.002) were associated with a lower primary patency rate. Patient age (P < 0.001), presence of diabetes (P = 0.023), length of stenosis (P = 0.003), early recurrence (P = 0.003) and presence of residual stenosis (P = 0.014) were associated with a lower secondary patency rate. CONCLUSION Patency of dysfunctional hemodialysis fistulas can be maintained safely with continuous follow-up and repeated interventions without shortening the venous segment by surgical revision. Percutaneous approach to hemodialysis access stenosis is an alternative to the conventional surgical approach and PTA is an effective treatment method for dysfunctional AVF.H emodialysis, and therefore patent hemodialysis access, is of great importance to patients with end-stage renal disease (ESRD). The preferred type of access in patients undergoing hemodialysis is an arteriovenous fistula (AVF) (1). The Kidney Disease Outcomes Quality Initiative provides evidence-based clinical practice guidelines for all stages of ESRD and reports autogenous AVF as the reference standard for primary vascular access, due to their longevity and low infection rates (2, 3). Sands et al. (4) and Schwab et al. (5) demonstrated a 10-fold increase in thrombosis rate of synthetic polytetrafluoroethylene (PTFE) accesses when compared to AVFs. Despite proven advantages of AVF over PTFE, both types of access eventually fail and contribute to multiple hospital admissions, radiological and surgical interventions, and overall morbidity associated with chronic hemodialysis. Significant stenosis causing access dysfunction is a frequent complication in hemodialysis and requires repeated percutaneous transluminal balloon angioplasty (PTA) to maintain patency (6-9). The patency of PTA is limited, however, with first year primary patency rates ranging between 26% and 62% (6-8). Many factors influencing the patency rate have been studied in previously reported series (7,8). Our study is the first to investigate the effect of early recurrence on secondary patency. MethodsThe records of 228 patients (129 men, 99 women; mean age, 56.8±14.6 years) who underwent first time PTA for a dysfunctional native AVF between January 2007 and January 2011 were retrospectively reviewed. Inclusion criteria were presence of a dysfunctional native AVF referred for fistulography and treatment, no previous history of stenosis or thrombosis, and only stenosis of the AVFs on fistulography. Patients who had synthetic dialysis, composite grafts, or autogenous fistulas that were already thrombosed were excluded from our study. Indications for fistulography included decreased flow rate, difficult cannulation, increased venous pressure, edema of the upper extremity, or pain during dialy...

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“…10 Ojha et al 16 used an in vitro model of an end-to-side 45° anastomosis similar to a radialcephalic anastomosis and found high correlation between areas of low wall shear stress and intimal hyperplasia. They admitted that this low wall shear stress and/or flow separation pathogenesis might not explain events in the arterial end, which seems to be subjected to a complex hemodynamic environment.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Swing-Segment Stenosis in Referred Dialysis Patients With Angiographically Documented Lesions

Badero

Salifu

Wasse

et al. 2008

American Journal of Kidney Diseases

112

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Outcome and Prognostic Factors of Restenosis after Percutaneous Treatment of Native Hemodialysis Fistulas

Cited by 178 publications

References 22 publications

Access Flow Monitoring of Patients with Native Vessel Arteriovenous Fistulae and Previous Angioplasty

Access Flow Monitoring of Patients with Native Vessel Arteriovenous Fistulae and Previous Angioplasty

Percutaneous transluminal balloon angioplasty in stenosis of native hemodialysis arteriovenous fistulas: technical success and analysis of factors affecting postprocedural fistula patency

Frequency of Swing-Segment Stenosis in Referred Dialysis Patients With Angiographically Documented Lesions

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